<p>Economic Burden Of Inappropriate Empiric Antibiotic Therapy: A Report From Southern Iran</p>

Abstract

IntroductionWidespread inappropriate antibiotic prescribing by healthcare professionals in the hospital setting is a great concern that may cause many undesirable consequences. Adherences to antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens and reduce the unnecessary variations in the practice among practitioners. The objective of this study was to evaluate the prescription patterns of empiric antibiotic therapy in relation to treatment guidelines and the economic burden of discordance with guidelines in a major referral Iranian university hospital.MethodHospital records of hospitalized patients with empiric antibiotic prescription, from September 2016 to February 2017 were reviewed. The process consisted of comparing empiric antimicrobial administration with institutional guidelines for each patient by a clinical pharmacist and an infectious disease specialist to evaluate the appropriate utilization of antibiotics. Adherence to guideline, the cost of antibiotics usage for each patient and the excess cost consequent from discordance with guideline was calculated.ResultsThe most inappropriate prescribed antibiotics were carbapenems and aminoglycosides. Overall guideline adherence was 27.8%. Frequency of antibiotic usage incompatibility with the guidelines on the basis of dosing interval, duration of therapy and drug indication were 31.46%, 29.44% and 19.36%, respectively. General surgery and internal medicine wards had the least and the most inappropriate antibiotic administration, respectively. Totally antibiotic usage cost was 578,959.39 USD (24,316,294,800 Iranian Rials, IRR) for 6 months, which the excess costs of inappropriate antibiotic prescribing, was 471,319.69 USD (19,795,427,225 IRR). The estimated annual excess cost is 942,639.38 USD (39,590,854,450 IRR).ConclusionIn this research, physicians’ adherence with guidelines for empiric antibiotic therapy was low which was led to 471,319.69 USD excess costs. These results urge institution policy makers to develop guidelines to ensure active dissemination and implementation of them to decrease inappropriate antibiotic usage.

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

“…6 This issue can be even more evident in low income countries due to their inefficient vaccination policies, higher rates of infectious diseases, the unavailability of a variety of effective antibiotics, and even laboratory techniques, instruments, and media required for the accurate identification of apathogen. 7,8 Considering that antimicrobial consumption has almost doubled in Iran during the past decade, 9 and inappropriate empiric antibiotic therapy has been reported to be high, 10 without doubt AMR is an issue in the country that must be looked into. In addition to significant mortality, AMR has been reported to add as high as trillions of dollars of cost burden to nations.…”

The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice

“…28 This will impose severe financial and service burden in the hospitals and negates the therapeutic outcome. 29,30 Considering criteria and standards while prescribing as well as initiating antimicrobial stewardship programs will potentially preserve antimicrobials like ceftriaxone from becoming ineffective. 31 The inappropriate use of ceftriaxone was found to be higher in HFSUH when compared to the other hospitals included in the study.…”

“…28 This will impose severe financial and service burden in the hospitals and negates the therapeutic outcome. 29,30…”

A game theoretic approach reveals that discretizing clinical information can reduce antibiotic misuse

“…Consequently, the utility of each outcome is simply the conditional probability of survival. Importantly, the utilities in the model can include other aspects not mentioned above, such as drug side effects, quality of life, financial costs, or other indirect costs 6 , 55 . The only assumption we make is that the order of preferences, based on the utility values, is preserved ( r 3 > r 2 > r 1 ).…”